Nosebleeds (Epistaxis)
Nosebleeds (Epistaxis)
Most nosebleeds are harmless and resolve on their own, but recurrent or heavy bleeding from the nose can be distressing and disruptive. When nosebleeds are frequent, prolonged or difficult to control, specialist assessment and a simple in-clinic treatment can resolve the problem quickly and effectively.
What causes nosebleeds?
The inside of the nose has a rich blood supply, and the vessels on the nasal septum are particularly close to the surface and prone to bleeding. Identifying the contributing factor guides the most effective treatment.
Drying out the nasal lining makes the mucosal surface fragile and vessels more prone to rupturing. This is one of the most common and easily addressed contributing factors.
A common cause, particularly in children. Repeated minor trauma to the same area of the septum can create a persistent bleeding point.
Inflammation of the nasal lining increases the tendency to bleed, which is why nosebleeds are sometimes associated with sinusitis or allergic rhinitis.
Sprays applied directly onto the septum rather than the outer nasal wall can cause localised dryness and bleeding. A simple technique correction often resolves this.
Aspirin, warfarin, apixaban and similar medications increase bleeding tendency and can make nosebleeds harder to stop and more frequent.
Does not directly cause nosebleeds but makes them more difficult to control. A nasal septal abnormality or prominent vessels on the septum can also be a contributing factor.
First aid for a nosebleed
Correct first aid controls the majority of nosebleeds without further intervention.
What to do
Sit upright and lean slightly forward — do not tilt the head back. Pinch the soft part of the nose firmly, just below the bony bridge. Hold for a continuous 10–15 minutes without releasing. Breathe through the mouth. Apply a cold compress to the bridge of the nose if available. Avoid blowing the nose immediately after a bleed as this can dislodge the clot.
When to seek emergency care
Seek emergency care if bleeding is very heavy and not controlled after 20–30 minutes of sustained direct pressure, or if you feel faint or unwell. Avoid stuffing tissues deep into the nostril — this does not control bleeding and can make it harder to assess. If you are on blood thinning medication and the bleed is not controlled, seek medical advice promptly.
How Ms Mushi assesses and treats recurrent nosebleeds
At your consultation
Ms Mushi will take a history of the frequency, duration and severity of your nosebleeds — which side they come from, how long they take to stop, any relevant medication and medical history. She will examine the inside of the nose using a nasal endoscope to identify any bleeding points, prominent vessels or associated nasal pathology such as rhinitis, a deviated septum or septal perforation.
Treatment options
Naseptin cream — an antiseptic cream applied to the inside of the nose that softens the nasal lining, reduces crusting and promotes healing of fragile vessels. Often sufficient for mild or infrequent bleeds.
Silver nitrate cautery — a quick, well-tolerated in-clinic procedure under local anaesthetic. A silver nitrate stick is applied precisely to the bleeding vessel, sealing it and preventing further bleeding. Only one side is treated per sitting to protect the septal blood supply. Results are typically immediate and lasting.
Where nosebleeds are severe or not controlled by the above, Ms Mushi will arrange appropriate onward management.
When should you seek a private ENT opinion?
A private consultation with Ms Mushi means you will be seen within days, with cautery available at the same appointment where clinically indicated.
Nosebleeds occurring more than once a week
Nosebleeds that take more than 15–20 minutes to stop
Nosebleeds affecting sleep or daily activities
Bleeding from both nostrils or from the back of the throat
Nosebleeds associated with nasal blockage, crusting or discharge
You are on blood thinning medication and experiencing recurrent nosebleeds
A single severe episode that required hospital attendance
Frequently asked questions
Is silver nitrate cautery painful?
The procedure is performed with local anaesthetic spray applied to the inside of the nose. Most patients find it very well tolerated. There may be mild discomfort or a brief burning sensation during the procedure, which settles quickly. The whole process takes only a few minutes.
Can both sides of the nose be treated at the same time?
No — it is not safe to cauterise both sides of the nasal septum at the same sitting, as this risks damaging the blood supply to the septum. If both sides require treatment, the second side is treated at a separate appointment at least six to eight weeks later.
Will the nosebleeds come back after cautery?
Silver nitrate cautery is highly effective for anterior (front of nose) bleeding points and produces lasting results in the majority of patients. Some patients require a second treatment. Ongoing care of the nasal lining with Naseptin cream helps maintain the result.
Should I stop my blood thinning medication before the procedure?
Do not stop any prescribed medication without speaking to your GP or prescribing doctor first. Ms Mushi will advise on this at your consultation based on your individual circumstances.
Can children have this treatment?
Nosebleeds are very common in children. Naseptin cream is often tried first. Silver nitrate cautery can be performed in older cooperative children under local anaesthetic; younger children may require a general anaesthetic for the procedure to be done safely.
Book a consultation for recurrent nosebleeds
Ms Mushi treats recurrent nosebleeds at Circle Cheshire Clinic, Northwich, with cautery available at the same appointment where clinically indicated. Appointments are typically available within days.